Extended lateral column tibial plateau fractures. How do we do it?

Abstract

We describe the operative management of extended lateral column fractures according to the revised three-column classification approach in a step-by-step fashion. We show that direct reduction and stable fixation of extended lateral column tibial plateau fractures via a limited arthrotomy and tibia condyle osteotomy, with the use of free subchondral 2.7 mm locking screws is a reliable technique. Subsequently, diverging VA-LCP locking screws further improve the structural properties. It is a straightforward technique and the single lateral approach (Lazy-S) facilitates direct reduction of the articular surface and stable fixation of the fracture fragments under direct vision with good radiological and fair functional outcome.

Extended approach to the lateral tibial plateau with central meniscal subluxation in fracture repair: feasibility and first clinical and radiographic results

“…Several other approaches are described that allow to address the posterior aspect of the lateral plateau: It is possible to osteotomize the lateral tibial condyle, especially useful in such cases, where an osteotomy completes a split component. This technique allows direct desimpaction and grafting of the depressed joint line [23]. Moreover, as Hu described, it is possible to get access further posteriorly using a modified anterior-lateral supra-fibular approach, in which the LCL is identified and retracted with the knee in a 60° flexion [24].…”

“…The arrow and numbers 1 and 2 show once again the depression and the two main fragments corresponding to the markings on a; c Intraoperative coronar 3D scan after allograft implantation and first preliminary reduction attempt secured with wires, below a lateral fluoroscopic image which shows the double plate placement; d Final intraoperative 3D scan after allograft implantation and finalized ORIF the cases after a median follow-up of 8.3 (IQR 4.3 range 3-14.5) months. None of the ten cases required a postoperative revision surgery.The clinical Rasmussen-Score had a median value of 25 (IQR 2.8, range[21][22][23][24][25][26][27][28][29]. Two patients (20%) had excellent (with score > 27) and the eight (80%) had good (score 20-26) clinical results.…”

3D mapping and classification of tibial plateau fractures

“…This high-incidence fracture line trajectory offers a ready-made intra-articular osteotomy of the lateral condyle through the anterolateral approach. 39 - 41 Figure 7 shows that the extorsion of Gerdy’s tubercle fragment with the ITB can provide a clear surgical field for reduction, instead of the extensive detachment. The maintenance of the bone-tendon interface between the ITB and Gerdy’s tubercle is essential to postoperatively reducing the anterolateral instability.…”

Limited value of the column concept in the operative management of posterior column tibial plateau fractures

“…Using variable angle -locking compression plates (VA-LCP) with a 30 degrees' cone allows us to diverge the VA-LCP locking (rafting) screws posteriorly through the fracture and ensure adequate fixation and articular support of extended lateral column fractures (Figure 1). Nevertheless, lateral ORIF does not always provide sufficient support of posterolateral (and posteromedial) column fractures (Figure 1) [11][12][13]. Surely enough, only 3/42 patients (7.1%) with a combined lateral and posterior column fracture were treated according to the TCC (i.e.…”

“…In conclusion, the outcome scores of patients after sustaining a PCF were markedly lower than values in the reference population. Although the current revised three-column classification approach is very helpful toward surgical planning, in particular of extended lateral column fractures [11], there are still multiple issues that need to be addressed. Fracture patterns of multiple column fractures seem to be more comprehensive than can be adequately expressed by the TCC.…”